Tuesday, 17 February 2015

Can robots help care for us as we age?

Tony Prescott

Where'd my robot go?

In fifteen years there will 50% more over 65s than there are
today, and the proportion of older people in our society will continue to grow for
some time after that. The 2013 House of
Lords report Ready for Ageing? looked at the likely consequences of this
on-going demographic shift and stated the problem plainly: “The UK population
is ageing rapidly, but the Government and our society are woefully
underprepared”.

On 5th March politicians from all parties will appear
at an event
in London, organised by the Guardian newspaper, to explain their policies for
addressing the ageing challenge. I hope
they offer some ambitious proposals: the status quo is not an option.

The Ready for Ageing
Alliance, a coalition of charities and think-tanks, has already produced its
eleven-point
manifesto for action. Its focus is
primarily on what we as individuals can do to meet the coming challenge,
emphasising healthy living, active lifestyle, saving for retirement, forward
planning, being part of social networks, staying positive.

Of course we can each play our part, but that won’t solve
the problem. Our pension, health and social care systems are already under
severe strain. How will they cope as the pressure mounts?

I’ll be looking to see how much thought the politicians have
given to how new technologies could help. I was amazed how little the House of Lords
Committee said about this. In over
a thousand pages of material there is barely a mention of the potential of new
developments such as the internet of things, smart homes, and robotics. Of
course, as the Lords report points out, new technologies are not a panacea. However,
we are a nation of inventors, designers and entrepreneurs, and in the past we
have often used these talents to help us out of tight situations. Given the current challenge, we would do well
to sharpen our vision and look where human ingenuity could take us.

The current telehealth technologies are mainly about
monitoring and providing healthcare advice. The underlying digital computer and
telecommunications technologies have a fundamental limitation: they can’t physically
act in the world. This is where robots are different and can make a game-changing
contribution.

In a recent
blog piece for Wired magazine I described a number of ways that assistive
robots could help us as we age: maintaining our environments by doing chores
like cleaning, and helping us with eating, toileting, and dressing. In that
piece, I make it clear that these robots are unlikely to be human-like or ‘humanoid’.
Rather, many of them will be home appliances that simply do more by themselves.
The current generation of robot vacuum cleaners exemplifies this possibility. We shouldn’t feel surprised or threatened by
this development: it continues a
long-term trend. After all, look at what happened with the first form of
automation to enter the home – the washing machine. We no longer wash clothes
by hand or squeeze out water with a mangle. Assistive robotic technologies will evolve
along similar trajectories. By 2030,
robot cleaners and helpers will be part of a larger ecology of smart devices
that will have transformed the way we perform household tasks, making our
living spaces easier to manage as we grow old.

Assistive
robots can also help at a more personal level.
Together with the designer, Sebastian Conran, and with advice
from occupational therapists and ex-patients from Sheffield Teaching Hospitals,
I am currently developing a robotic
over-bed table. If disability confines
you to bed or to a wheelchair, our table will come to you rather than you go to
it. When you are finished with the table
it will move back to a safe place and recharge.
This is a not major breakthrough in robotics - the AI required is
similar to that of the robot vacuum cleaner - but our main challenge is to make
the table completely safe and genuinely useful. We imagine that one situation where people
will use these tables is within hospital wards so they need to be able to move
around safely within the ward without bumping into people or other objects. Once they are in position over a bed they
also need to self-adjust safely, and to ensure that any objects placed on the
table top do not fall off. Each of these
challenges requires appropriate sensing and some significant artificial
intelligence.

At a still
more intimate level, consider personal hygiene. Smart toilets that can provide
cleaning and drying of intimate areas are already in widespread use in parts of
the world such as South Korea and Japan. In the coming decade, we can extend
the functionality of intelligent bathroom fittings so that they are more useful
to people with age-related disabilities. For many people, being helped with their
personal hygiene by a carer - potentially a complete stranger - is embarrassing
and demeaning. Assistive robots can help
us retain control over our lives and our bodies, allowing us to live
independently for longer.

People also worry that using technology in this way might increase
the isolation that is already
often a problem for older people.
The current generation of telehealth technologies puts some aspects of
care at a distance, and assistive robots will replace some tasks that human
carers do now. We need to take this issue
seriously and in my view we should protect access to face-to-face human support
by legislation.

However, I don’t think it’s inevitable that using new
technologies to support our independence will lead to other people drawing
back. Indeed I think that the reverse
might happen. Research
on loneliness shows that lack of control over your life can lead to
passivity and learned helplessness, feeding low self-esteem and social
withdrawal. Becoming more independent
through technology might enable us to feel better about ourselves, get out of
the house more, seek and maintain human contact, and enjoy positive
relationships that are not all built around a carer-client dynamic.

There is already evidence that companion robots could help
us in our social lives. The Paro
seal, an animal-like robot developed in Japan, is currently being evaluated
in Sheffield for its capacity to promote social interaction in patients with dementia. Preliminary
results show that Paro can increase socialisation in people who are
withdrawn by encouraging them to converse with others and by eliciting
non-verbal interactions, such as touch and stroking, with the robot.

Companion robots, such as the Paro seal,

encourage people to socialise and could

provide a therapeutic value similar

to that of a pet animal.

Photo: Claire Jepson.

Some are
concerned about how assistive robots might impact on the caring
professions. However, good professional
carers are already scarce and are becoming scarcer. The UK has a shortage of nurses
and residential care workers, and this will only worsen as the number
of care jobs increases by up to one million by 2025. Robots can help compensate for this skills
shortage by assisting professional carers in their work, and by reducing
work-related injuries, such as chronic back-strain, that otherwise lead some
experienced carers to retire early. Working
with teams of assistive robots, the role of a professional carer will become
more skilled and respected, less physical, less routine, and more focused on
the people being cared for. Wages and
working conditions for care workers are often scandalously poor: introducing
more technology into care work could raise its status.

Across
Europe, we are moving from a situation where we have three working people for
every one potential dependent (someone either over sixty-five or below
eighteen) to one where, by 2060, that ratio
could be one-to-one. The world in 2060 will be very different, and
it is not unrealistic to imagine that assistive technologies will be very
advanced by that time. This is good to
know, because otherwise families will be faced with what looks like an
impossibly high burden.

The House of Lords is right to think that technology can’t
fix all of the issues arising from this demographic shift. However, I believe that it can and should be a
part of the solution, and robotic technologies will have an important role to
play. The problems arising from our ageing
population won’t happen overnight, but as we look around and see more of our
older citizens miserable and neglected, we need to think about what actions we can
take and to start rethinking how our society cares for older people. As part of the mix, I believe we would be
doing a disservice to both ourselves and our children, to ignore the
opportunity provided by assistive robots.

Tony
Prescottis a Professor of
Cognitive Neuroscience at the University of Sheffield, a Fellow of the British
Psychological Society, and the Director of Sheffield Robotics (http://www.sheffieldrobotics.ac.uk) a cross-institutional robotics facility
with over one hundred active researchers.
He regularly speaks and writes about the potential societal impacts and
risks of advanced technologies such as AI and robotics. You can follow him on
Twitter @tonyjprescott.

6 comments:

Here are your true challenges: Caring, like so much of the work that women have done historically, is both undervalued and underpaid. It has little status, as do those performing it. Caring can be hard emotional work, and there are few supports for those doing it, paid and otherwise. As health care has become more mechanized and quantified--and because quantifying elements of care (particularly the emotional work) is so difficult to do-- expert carers are finding themselves hemmed in by limitations that harm their work, and that make their expertise nearly invisible.Your nation, like the US, has millions of people out of work, students and young folks leaving school with bleak futures. We both face increasing social isolation and stratification. Better pay and conditions for health carers --and the tools that help them--would solve many of those problems; machines won't.Assistive technologies, like any tools, do and will continue to shape our models of healthcare, so what will greater mechanization mean for our health and caring solutions? And these ATs *are* tools, they are not carers. (I think your headline is a bit misleading in that regard.)A larger issue, the overwhelming issue, in fact, is: what do we mean we speak of care?

Hi Angela, thanks for sharing your thoughts. I agree with a lot of what you say, particularly that we need to value the emotional aspects of care. The goal of the assistive technologies that I want to develop is to help people to live independently as they grow older. I was careful to say that these technologies are not the solution to the problem of social isolation. But can they help to address to the problem of isolation? Yes, potentially. Technologies such as the telephone and the internet already help to reduce isolation, and there is now evidence that a robot, such as the Paro seal, can also do so for people with dementia by providing intellectual and sensory stimulation and by acting as a social facilitator. Assistive robotics can help in an indirect fashion too. For example, in the UK right now social care visits can be as short as fifteen minutes per day, and the number of tasks that a carer might need to do during a fifteen minute visit does not leave much time for social interaction. Technologies that help with the more mundane aspects of supporting people’s basic needs (we don’t need to call this care if you prefer), feeding, cleaning, toileting, and that therefore allow people to be more independent, will leave professional carers more time to spend with the person, doing the important emotional work that you talk about. Indeed, I see your goals and mine as complementary. I want to make care better valued, and I think we can do that by taking away some of the physical drudgery of care work.

This is a really interesting area of study. I have seen existing telecare provision help people stay at home independently and so can definitely see it's promise. Care delivered at home by carers who are paid too little, given too little time and too many tasks to deliver it in a person centered care is sadly not unheard of. If technology could be developed to tick some of these 'tasks', leaving the carer to sit with, talk to and connect with the person they were caring for, the potential benefits are huge. I can see that this is how the technology is being proposed, as an enhancement rather than a replacement of human contact. A Both / And.

My main concern comes from the fact that we live in a society of Either / Or... particularly when it comes to public funds. I find it hard to imagine that there is any way in which people will be allowed to keep their care provision if there is technology to 'tick off the tasks' that a carer was doing. Cost-saving is such a powerful driver, that funding a carer to connect with an older person when all the jobs have been done seems, sadly, like a utopia that is far removed from practice, particularly in austere times.

And related to this, it is interesting to me that this technology is proposed for use for older people. The discourse of 'demographic time bombs' and 'grey tidal waves' creeps into discussions about developing practice for older people. To me, this raises the implication that cost-saving in order to 'cope' with more older older people is the reason that the powers that be are engaging with these innovations. This makes me worry further about the potential for technology to be used to 'replace' human contact (although again I do realise this is not what the author is proposing).

One final concern about the demographic time-bomb rhetoric is an ethical one, which relates to how older people are viewed in our society. We do not, for example, hear about a 'toddler tidal wave' and discuss the social problem or panic posed by having too many babies being born for the number of school places. We simply build more schools; we might use the word 'challenge'. I don't think it's an accident that government is engaging with the idea of care technology for older people rather than other groups. I would imagine the idea of 'robots' in nurseries or replacing teaching assistants because of the cost of there being too many children would be met with outrage. Somehow, it is easier to propose such things for older people, because society is invested in the pernicious narrative of older people as a costly problem to be solved. Several of the comments on Twitter picked up on the risk of de-humanising people by offering technological rather than human care. As a society, we find it easier to de-humanise older people.

Again, I realise that is not the driver for / understanding of the technology that is being proposed here. And again, I can see its potential for enhancing older people's personhood by promoting independence, enhancing control etc. My concern comes from the fact that the technology is not being dropped into a vacuum, and its impact may deviate from its intention as a result of social attitudes to older people or funding pressures.

These issues are not new to those of us who are passionate about care for older people, so we will just need to include ethical use of technology as part of our battle to make sure that our society values older people and sees them as the resource they are.

My primary motivation for developing assistive robots is to improve quality of life and increase independence. I think we should do this regardless of whether the proportion of older people in our society is changing or not. But the on-going shift in demographics in the developed world gives this added urgency. Birth rates rise and fall and you are right that society adjusts to such fluctuations with little fuss. But the coming change in the demographic make-up of our society, due to advances in modern medicine and diet, is unprecedented in human history. To see the scale and likely economic and social consequences of the forthcoming change I would encourage everyone to look at the House of Lords report. I agree we shouldn’t over-dramatise, or use overly emotive or negative language, living longer is something to celebrate after all. But equally we shouldn’t under-estimate the potential impacts of this shift when there are opportunities to mitigate its worst consequences by acting now.

I understand that people are worried about social isolation and dehumanisation. But these technologies are being developed to boost independence not to increase isolation or dehumanise. To be against a development A that is positive because it might have some side effect B that is negative, does not make much sense to me. Rather I think we should say, lets do A, and lets do whatever is necessary to make sure that B doesn’t happen. I have written a short paper (http://www.abrg.group.shef.ac.uk/pubs/view.php?id=282) about the risk that assistive robots could increase isolation and my view is (i) that the risk is over-stated, and (ii) that there are lots of actions we can take to prevent these negative outcomes. For instance, the demographic shift will give older people a stronger political voice. Why not use this to strengthen legislation to include a statutory right to human contact for people in care?

Concerning whether robotic technologies are dehumanising. We already use many machines in care, think of the electric wheelchair, the stair-lift, the pacemaker, the dialysis machine, the iPad. Would we want to give up these technologies as dehumanising? To do so would surely be as counterproductive and pointless as going back to washing all of our clothes by hand. Looking forward then, if we could replace the wheelchair by an exoskeleton to allow someone to walk again that surely is to be welcomed. If we can add robotic functionality to a commode, so that someone with disability can use it without help, doesn’t this restore dignity rather than dehumanise? If a robotic device could allow someone to feed themselves rather than having to rely on others to feed them, doesn’t this empower that person?

By helping people to live independently as they age we also relieve a significant and growing impact on others, helping them to see longer life as a positive, and to value older citizens for the continuing contribution they can make. Technology can assist us to live more active and useful lives as we age and could therefore help to drive the shift in attitudes towards old age that you are hoping for.

As time goes by, and technology advances, we can all expect to experience increasing robotisation of our activities of daily living. This seems like a generally positive prospect and I cannot help but wonder if part of the problem people might have with it is due to the connotations of the word "robot". Perhaps people might find the prospect of increasing "automation" of mundane tasks more agreeable.

Common perceptions of robots are often related to what we see in cinema: robots like ED-209, HAL, Replicants and The Terminator. We are cautioned about the risks of AI and robots, especially robots designed to look and/or act like humans. I am writing this content on an Android Nexus phone, and must admit that a part of me wonders whether Google's in joke based on Philip K Dick's "Do Androids Dream of Electric Sheep" and the subsequent film might turn it to be more prophetic than they had hoped.

I am also aware that repetitive, mundane tasks can actually be beneficial, especially when done mindfully. I imagine this would be more effective when applied to something like washing up as opposed to personal hygiene. Having lived in Japan for two years, I can attest that their loo seats are a wonderful invention, with the added side benefit that they would reduce paper waste dramatically. Perhaps we need to consider why we have not adopted them more widely here : does it jarr too much with our cultural sensitivities? Are they simply too expensive?

Automation of more laborious tasks in order to allow people to have a better quality of life or be more independent is probably a good thing on balance, as long as it does not result in people being left alone more. If it does result in more care time being spent engaging with people as hoped, that would be a good outcome too. Safety benefits, such as systems that recognise and intervene when the gas has been left on, or other potebtially grave situations, could also be very helpful.

P.S. in order to post this comment, I had to prove that I myself am not a robot, which I hope allays any suspicions you might harbour.

About the Salomons Centre

The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.